Behavioral Treatment of Menopausal Insomnia; Sleep, Depression, Daytime Outcomes

更年期失眠的行为治疗；

• 批准号: 8723894
• 负责人: CHRISTOPHER L DRAKE
• 金额: $ 40.14万
• 依托单位: HENRY FORD HEALTH SYSTEM
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-01 至 2018-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8723894
• 关键词: Acute; Address; Adult; Adverse event; Affect; American; Arousal; Behavior Therapy; Biofeedback; Biological; Chronic; Chronic Insomnia; Clinical; Clinical Trials; Cognitive Therapy; Comorbid Insomnia; Depressed mood; Development; Disadvantaged; Disease; Distress; Effectiveness; Endocrinologist; Evidence based treatment; Fatigue; Frequencies; Gonadal Steroid Hormones; Guidelines; Health; Heart Diseases; High Prevalence; Hormone replacement therapy; Hygiene; Impairment; Laboratories; Link; Longevity; Maintenance; Major Depressive Disorder; Malignant Neoplasms; Measures; Menopausal Symptom; Menopause; Mental Depression; Morbidity - disease rate; Outcome; Patient Self-Report; Patients; Pattern; Performance at work; Pharmaceutical Preparations; Pharmacological Treatment; Pharmacotherapy; Placebos; Polysomnography; Population; Postmenopause; Primary Health Care; Primary Insomnia; Psychologist; Quality of life; Relative (related person); Relaxation Therapy; Research; Risk; Sleep; Sleep Disorders; Sleep Initiation and Maintenance Disorders; Sleep disturbances; Sleeplessness; Specialist; Stimulus; Symptoms; Testing; Time; Training; Vasomotor; Woman; base; cancer risk; depressive symptoms; design; economic cost; efficacy testing; evidence base; experience; falls; health care service utilization; heart disease risk; improved; medical specialties; public health relevance; sleep onset; traditional therapy

DESCRIPTION (provided by applicant): Insomnia is recognized as one of the most prevalent and costly sleep disorders and is associated with considerable morbidity including significantly reduced quality of life, impaired work performance, and increased risk for major depressive disorder.1-4 Insomnia is a key symptom of the menopausal transition with 40-50% of postmenopausal women (> 17 million) having insomnia.5,6 Insomnia associated with menopause has a pattern of sleep disturbance predominantly characterized by sleep maintenance difficulties including frequent awakenings and arousals, reduced sleep efficiency, and overall fragmented sleep. It has recently been demonstrated that this pattern of sleep disturbance, difficulty maintaining sleep, increases throughout the progression of menopause.7 We have recently found sleep maintenance problems in menopause are associated with reduced work performance, increased healthcare utilization, and impaired quality of life.8 Historically, menopausal symptoms including sleep disturbance, were treated using hormone replacement therapy (HRT). However, evidence linking HRT to increased risks of heart disease and cancer have led to a 40% reduction in the use of sex steroid hormones by postmenopausal women and highlight the need for alternative approaches to treatment.9 Importantly, the American Association of Clinical Endocrinologists guidelines for management of menopause do not address treatment of menopausal-related insomnia due to the absence of research findings in this area.10 Cognitive-behavioral therapy for insomnia (CBT-I) yields equivalent short-term efficacy and superior long-term durability to pharmacological treatment of insomnia. However, the efficacy of cognitive behavioral therapy for insomnia comorbid with menopause, one of the primary focuses of the present proposal, has not been tested. Traditional CBT-I has disadvantages however, including the need for a trained therapist and significant time commitment on the part of the patient. Therefore, widespread availability of multicomponent CBT-I is limited by the relatively low number of CBT sleep specialists, complexity of therapy, and patient burden. Thus, another aim of this project is to test the acute and long-term efficacy of a single component behavioral therapy for menopausal-related insomnia. Given the significant daytime impairment present in insomnia comorbid with menopause including depression, quality of life, and fatigue, a final aim of this proposal is to determine the efficacyof CBT-I on these measures in women with menopausal-related insomnia.

描述（由申请人提供）：失眠症被认为是最普遍，最昂贵的睡眠障碍之一，并且与相当大的发病率有关，包括显着降低生活质量，工作障碍和增加重度抑郁症的风险。1-4失眠症是与40-50％的女性相关的40-500百万次置于妇女的关键症状。更年期的睡眠干扰模式主要以睡眠维持困难为特征，包括频繁觉醒和唤醒，睡眠效率降低以及整体零散的睡眠。最近已经证明，这种睡眠障碍的模式，保持睡眠的困难，在整个更年期的整个过程中增加。我们最近发现更年期的睡眠维持问题与工作绩效的降低，医疗保健利用率的降低以及生活质量受损有关。历史上，在包括睡眠干扰在内的更年期症状，使用荷尔蒙替代治疗（Hrt）。然而，将HRT与心脏病和癌症的增加联系起来的证据导致绝经后妇女使用性类固醇激素的使用降低了40％，并强调了对治疗的替代方法的必要失眠症（CBT-I）的认知行为疗法具有等效的短期疗效，并且长期耐用性可用于失眠的药理学治疗。然而，尚未测试认知行为疗法与绝经（本提案的主要重点之一）合并失眠的功效。但是，传统的CBT-I缺点，包括需要训练有素的治疗师和患者的大量时间承诺。因此，多组分CBT-I的广泛可用性受到CBT睡眠专家数量相对较少，治疗的复杂性和患者负担的限制。因此，该项目的另一个目的是测试单个成分行为疗法对绝经相关的失眠的急性和长期疗效。鉴于与更年期（包括抑郁症，生活质量和疲劳）合并失眠的白天障碍，该提议的最终目的是确定CBT-I对绝经相关的女性这些措施的效率。